@physioLojik Hi,hope you can help me clear this up,reading some threads on estrogen,AI’s and nolva.
Serrano says he rarely use AI’s on patients but instead nolva while on test,estrogen is needed to get lean,get it up among other things. So the bottom line is to keep my anastrozole in the drawer,and when i start test e,buy some nolva to have on hand,or start to use it from the first day i pin the test and not stop the nolva as long as im on test?
My P-Estradiol was at 0.09,not sure if it is nmol//L - 90 pmol/L? Range is max 0,20. This was 7.12-2016.

Yea blind. Totally. Aren’t you an engineer? I’m a doctor. And that doesn’t mean I know everything. But i certainly don’t go on engineering forums and throw around some terms and act like I know things which sadly I don’t. But that is totally ok - you have some forum props from people and I run a low t center. Keep making yourself believe your nonsense. Explain to me how binding affinity is increased for estradiol when there is also increased testosterone since the amount of receptor sites don’t dramatically increase. Oh yea it isn’t. So what matters is the ratio of testosterone to estrogen. This is basic. So having linerally increased estrogen makes sense with increased test above baseline. Oh but you also said e1 and e3 don’t matter. I guess between serrano and myself we’ve probably seen over 25k patients being treated for hormone issues - how many have you treated? Oh yes and shadowpro on here must be blind too since he has no androgen experience. Or dr serrano. Or John meadows. Or anyone else who actually uses gear. And those are just people who have written for this site as authors and contributors. . Not forum warriors. @Shadow_Pro thoughts? Lol

As far as i understand,nolva binds to reseptor and blocks it from estrogen,but the estro is still avaliable in the system. When still in the system,that also mean its free to raise from conversion from the test i inject right? this can get too high and give me the bad effects of it? But is this likley not because of the rather low dosage of the test? if it happens,then i should introduce AI in addition to the 20mg of nolva a day?

You do realize that on an engineering forum they do not even ask your credentials.They can do the math and see if you are right. If you are right, they don’t care if you are a high school drop out. Your methods are the exception among doctors who run low t centers. Your ideas on ratios seem interesting. And likely the standard levels of E2 are off when we are talking about super human testosterone levels. But before getting too arrogant with “I am a doctor therefore I am god” that does not go over well with guys who have seen doctors prove themselves to be totally ignorant on this subject.

Over 25,000 individual patients between 2 doctors…speaking of math are you sure it isn’t less than half that?

I not saying your methods are not valid ones.But the standard method KSman promotes has a very long successful record. Your argument would be with a lot of the other doctors working in your specialty.

I hope that is not coming off as me tearing into you. You are the only guy talking in terms of the higher levels that a lot of guys are running. A bodybuilding doc, your experience must be respected. And I do

Verne - thanks for the reply. Notice I said I am a doctor which doesn’t mean I know everything I certainly don’t. I’ve been lucky enough to work with some of the most progressive thinkers in this field in my career. People who actually use the meds they prescribe which is something that doesn’t happen much. And 25k patients is actually conservative over our careers. I run the low t and I’m also in an endo practice in Columbus. I see roughly 35 patients a day, the majority being hormone based. The argument that ksman puts out usually involves him coming into the pharm forum and telling guys using 500 plus mg of test a week that their e2 should stay around 22 is madness. Also, in the real world at our practice, guys who’s test levels are on the high end of normal typically feel best with their e2 between 50-70. Now I wish I could post credientials here but I discuss using illegal drugs and drugs off label on this site and it certainly isn’t worth losing my license over over in pharm I’ve posted some studies and an interview with dr serrano that John meadows took discussing the value of LH while on TRT and why we shy away from using AI. So many guys think their issues on TRT are estrogen based. Yes if your test is in normal range and your e2 is way out of range it isn’t good - hence why I always preach ratio of test to estrogen. Estrogen doesn’t have a higher binding affinity to the AR than testosterone does. If you have a normal ratio of the two then the binding pattern typically is the same. If you are someone with normal test and sky high estrogen it’s likely due to either liver issues or very high body fat - both of which we would address BEFORE putting someone on HRT.

It’s all good the analogy we give when it comes to t and e is kind of like a car. If you want your car to put out more power (testosterone) you should also expect the rpm (estrogen) to go up. Estrogen, being a derivative hormone of testosterone, should be elevated in someone with elevated testosterone. It’s just logic.

Just for clarification purposes, you said that those with supraphysiological T levels can expect to see high out of range E values and that’s ok, because the ratio between the two values is important, not just the values. In my mind, this creates two questions:

Men on TRT usually can expect a TT value between 600-1200, ie not supraphysiological T levels. In that instance, wouldnt you also want to see e2 values between 20-30 (ie not high since the most vital men ages 18-29 typically have an e2 value of 20-30) to keep an optimal ratio since T values wouldn’t be extremely high to buffer higher e2 levels?

With high e2 blood serum levels, even in the presence of high T blood serum levels, can’t this alone cause issues? Don’t we have receptors specifically designed for binding with testosterone and not estrogen and other receptors specifically designed to bind with estrogen and not testosterone? What I’m trying to understand is that if this were true, the ratio would matter less than the total blood serum levels because these estrogen receptors wouldn’t “see” the high T levels, only the high E.

Hey man. Good questions - with “normal” test levels you would want to see estrogen ROUGHLY in normal ranges but again it’s based mostly on how the patient feels. I’ve seen guys 9x out of 10 feel better with slightly elevated estrogen as opposed to low. How the patient feels matters much more.

Question 2 - no. There aren’t receptors that are specific to t and e. You have androgen receptors. They can be occupied by either. Estrogen and testosterone are EXTREMELY similar chemically. Just like you have high blood levels of e in your question you also have high blood levels of t. The only place you’d see a true difference is in the brain where you’d want higher e as it’s what triggers downstream LH

Appreciate the response physiolojik. I believe Albert Einstein said if you can’t explain a concept in simple terms to a 5 year old, you don’t really understand the concept, so no need to apologize for the quick summary, although I just realized I likened myself to a child

Haha you got it. Receptors are like a parking lot and the hormones are like cars. There are only so many spaces to occupy but they can allow both types of cars. When they’re full or “saturated” type cars can only keep driving around and get bound by SHBG or be metabolized by the liver. This is why, contrary to ksman saying e1 and e3 don’t matter, is why they do matter since these are the downstream hormones which can be reabsorbed and be changed back to active e2. It’s why you see guys with liver dysfunction and digestive issues that typically have the issues with t to e ratios messed up since those metabolites are reabsorbed. NAC, methylated b vitamins and fiber basically fix out of control metabolite recirculation. Also all you guys on trt should be asking for either saliva or urine testing. Blood testing for hormones gives almost no usable true info since hormone production and metabolism happens all day long and it’s extremely important to see what the metabolites are.

What is your recommended T/E ratio? How often do you prescribe an AI at TRT levels? In general do you recommend a similar protocol, multiple SQ injections per week? Just curious about ballpark guidelines as everything is patient dependent. Thanks for the insight and I appreciate your time.

Give or take - 3-5%. But that’s Variable. Before I will begin TRT on a patient I make sure their adrenal system is working well as their liver. Then we look at digestion and bodyfat. Then we can look at trt which I write as 3 injects a week. To answer your other question - I prescribe an AI in less than 5% of my cases and then it’s always extremely low dose aromasin.